| NPI | 1962738872 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 10824) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 2914) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2014-11-18 |